Injectable Collagen for the Treatment of Fecal Incontinence: Long-term Results
Injectable Collagen for the Treatment of Fecal Incontinence: Long-term Results
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DOI：
10.1097/dcr.0b013e3182805276
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发表时间：
2013-03-01
影响因子：
3.9
通讯作者：
Sagar, P. M.
中科院分区：
文献类型：
--
作者：
Maslekar, S.;Smith, K.;Sagar, P. M.
背景：大便失禁是一种令人痛苦且难以治疗的疾病。注射填充剂已被用来治疗被动性大便失禁。然而，还没有长期结果。 目的：本研究的目的是评估肛内注射胶原蛋白治疗被动大便失禁的长期临床有效性。设计：本研究是一项来自前瞻性收集数据库的回顾性队列研究背景：这项调查在大容量的三级结直肠科进行。患者：所有因内括约肌功能障碍而接受肛内注射胶原蛋白治疗被动大便失禁的患者2006年1月至2009年12月期间的数据被纳入研究。前瞻性收集包括人口统计详细信息、术前肛门直肠生理学和结果测量在内的数据，并保存在数据库中。 主要结果测量：测量的主要结果是克利夫兰诊所佛罗里达州失禁评分以及手术前和后续随访时对主观患者满意度调查问卷的回答。使用 SPSS v19.0 分析数据。 结果：对 100 名患者（70 名女性；平均年龄 61 岁（范围 36-82））进行了至少 36 个月的随访。 56 名患者 (56%) 的大便失禁评分从平均 14 分（范围 9-18）改善至平均 8 分（范围 5-14）。总共 68% 的人报告症状主观改善。 38 名患者 (38%) 需要重复注射胶原蛋白，另外 15 名患者需要第三次注射。第一次和最后一次注射之间的中位间隔为 12 个月（范围为 4-16 个月）。年龄是成功结果的唯一独立预测因素（p = 0.032）。没有发病率。 局限性：本研究因其非随机回顾性设计而受到限制。结论：对于被动大便失禁患者，将胶原蛋白注射到肛门内括约肌中是简单、安全且有效的，尽管大约一半的患者需要重复注射。
BACKGROUND: Fecal incontinence is a distressing condition that is difficult to treat. Injection of bulking agents has been used to treat passive fecal incontinence. However, no long-term results are available.OBJECTIVE: The aim of this study was to assess the long-term clinical effectiveness of intra-anal injection of collagen for passive fecal incontinence.DESIGN: This research is a retrospective cohort study from a prospectively collected databaseSETTING: This investigation took place in a high-volume tertiary colorectal department.PATIENTS: All patients who underwent intra-anal injection of collagen for passive fecal incontinence with internal sphincter dysfunction between January 2006 and December 2009 were included in the study. Data including demographic details, preoperative anorectal physiology, and outcome measures were collected prospectively and maintained in a databaseMAIN OUTCOME MEASURES: The primary outcomes measured were the Cleveland Clinic Florida incontinence score and the responses to a subjective patient satisfaction questionnaire before the procedure and at subsequent follow-up visits. Data were analyzed by using SPSS v19.0.RESULTS: One hundred patients (70 female; mean age, 61 years (range, 36-82)) were followed up for a minimum duration of 36 months. Fifty-six patients (56%) had an improvement in fecal incontinence score from a mean of 14 (range, 9-18) to a mean of 8 (range, 5-14). A total of 68% reported subjective improvement in symptoms. Thirty-eight patients (38%) required a repeat injection of collagen, and a further 15 patients required a third injection. The median interval between the first and final injection was 12 months (range, 4-16 months). Age was the only independent predictor of successful outcome (p = 0.032). There was no morbidity.LIMITATIONS: This study was limited by its nonrandomized retrospective design.CONCLUSIONS: Injection of collagen into the internal anal sphincter is simple, safe, and effective in patients with passive fecal incontinence, although repeat injections are necessary in approximately half of the patients.